A medical claims denial specialist manages denied or disputed insurance claims, reviews denial reasons, and initiates the appropriate appeals process. The role ensures claims are accurately documented, coded, and submitted in accordance with insurance and regulatory guidelines.
- Review denied claims and identify reasons for denial
- Initiate and manage appeals processes
- Communicate with healthcare providers and insurance companies to resolve discrepancies
- Gather additional documentation as needed
- Help prevent future denials and support the financial health of the organization
- Perform medical coding tasks, including correct code assignment and sequencing
- Review patient charts and documents for accuracy and verification
- Compile physician-documented information from multiple sources for reporting
Requirements & Qualifications
- CPC required
- Minimum 3 years of directly related experience
- Preferred experience in Cardiology
- Understanding of HCFA-1500 claim forms and re-billing processes
- Experience with medical coding guidelines and procedures, including ICD-9 and CPT
- Knowledge of CPT and ICD-10 coding and billing rules
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago
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